Queen Mary and local NHS blazing trail in pre-hospital care

A specialist emergency service, which takes senior doctors and state-of-the-art medical equipment on the road, is successfully treating many patients at the scene, potentially avoiding almost 1,000 ambulance trips to hospital and saving over £500,000 a year.

The research was undertaken by the Physician Response Unit (PRU) team which includes clinicians from Barts Health NHS Trust, and also Queen Mary University of London’s Professor Danë Goodsman.

The PRU is a collaboration between the Trust, London’s Air Ambulance Charity and the London Ambulance Service, which takes the emergency department to the patient, delivering safe and effective emergency care in the community.

The service also supports learning of two innovative under-graduate prehospital medicine courses. They are co-led by Professor Goodsman at Queen Mary’s Barts and The London Medical School and Dr Gareth Grier, Director of the Institute of Prehospital Care at London’s Air Ambulance. This year Queen Mary and the institute also launched a Masters course in Prehospital Medicine.

Doctor and senior paramedic on the road

The latest research, published in the Emergency Medicine Journal, shows that many patients seeking emergency care via ambulance can be managed outside hospital using the PRU, which is based at The Royal London Hospital and responds to 999 calls in northeast London. Staffed with a senior emergency doctor, in addition to an emergency ambulance crew clinician, the doctor’s experience enables the PRU team to treat a wider range of illnesses and injuries at the scene.

The PRU car carries advanced medication, equipment and treatments usually only found in hospital, such as instant-result blood tests, urine tests and sutures to stitch serious wounds. It also has a computer with access to patients’ electronic records, allowing the team to review hospital and GP notes.

Model being adopted across the UK

Barts Health, London’s Air Ambulance and the London Ambulance Service were the first in the UK to set up a PRU, launched in 2001. The innovative model has since been implemented across the UK, including in Wales, Oxford and Lincoln, with other parts of the country also looking to develop similar services.

Professor Goodsman, who was recently appointed the first Professor of Prehospital Medical Education in the world, said: “Queen Mary has been in the vanguard of developing prehospital medical education, and we have helped define and shape what is a relatively new specialty.

“I am confident a substantial amount of our programme content and processes will be adopted widely both in UK and abroad. The PRU is not only good for patients and for hard-pressed A&E services, it also provides exceptional training opportunities for the students on our ground-breaking courses. For both students on placement with the PRU and the clinicians working in the PRU team, it is a tremendous privilege and learning opportunity to work in people’s own homes. They gain a deeper insight into the lives of the people they serve and the full context of their illnesses.”

Popular with patients and clinicians

The study revealed that:

The PRU saw 1,924 patients over the 12 month period (September 2017-September 2018), averaging 5.3 per day, with 1,289 (67%) of patients being treated successfully in the community.

Of those managed in the community, 945 (73%) were likely to have been taken to hospital by a standard ambulance resource.

The PRU was estimated to deliver a reduction of 868 inpatient bed days and replaced the need for three ambulance responses per day, generating an estimated total net saving of £530,107 over the year.

98% of 52 patients surveyed were extremely likely to recommend the service.

Dr Tony Joy, Consultant in Emergency Medicine at Barts Health NHS Trust and Clinical Lead of the PRU, agrees that the service is likely to expand: “Our emergency departments and inpatient wards are under huge amounts of pressure, so the time is ripe for a service like this to be rolled out more widely.

“In addition to the patients benefiting, our clinicians are finding great reward and satisfaction from more collaborative working between the ambulance service and the hospital team.”

More information on Queen Mary’s pre-hospital medicine courses is available here: